Clinical outcomes of spinal schwannoma microsurgery

Abstract

Background: Gross total resection of solitary spinal schwannomas (SS) and preservation of neurological functions are the gold standard of treatment for symptomatic patients; however, some patients present with postoperative neurological deficit.

Objective: This study aimed to evaluate the neurological outcomes of SS microsurgery and identify the risk factors of postoperative neurological deficit among patients at the Vajira Hospital.

Methods: The following preoperative and postoperative neurological outcome measurements were reviewed at 1, 6, and 12 months according to the following procedure: Frankel Grading, McCormick Score, American Spinal Injury Association Grading, Karnofsky Performance Status Scale, and Japanese Orthopedic Association Score. The predictive values of various clinical factors were assessed.

Results: Fifty patients (mean age, 49.0  16.3 years) underwent the surgery, and 79.6% of them presented with pain. The tumors were located in the thoracic (27.3%), cervical (22.7%), and cauda equina (20.5%) regions. Most tumors were intradural/extramedullary (81.8%). A statistically significant improvement between the preoperative and postoperative neurological outcomes was observed (P < 0.05). Intraoperative blood loss (odds ratio [OR], 1.007; 95% confidence interval [CI], 1.001 - 1.013; P = 0.026) and operative time (OR, 2.629; 95% CI, 1.164 - 5.936; P = 0.02) were associated with postoperative neurological deficit.

Conclusion: SS may occur at any levels in the spine and is typically intradural in location. Treatment with microsurgery significantly improved the postoperative neurological outcomes of the patients. However, intraoperative blood loss and operative time are the risk factors associated with the occurrence of postoperative neurological deficits